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Ineffective Oxygen Delivery

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1. Ineffective Oxygen Delivery

Ineffective Oxygen Delivery Ineffective Oxygen Delivery Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ineffective Oxygen Delivery (...) Ineffective Oxygen Delivery Aka: Ineffective Oxygen Delivery , Nasal Catheter , Oxygen Tent II. Devices: Nasal Catheter (Avoid) Flexible lubricated oxygen catheter Holes in distal 2cm Advanced through nostril into pharynx behind uvula Risk of to adenoids and secondary Gastric distention or rupture if cannulate esophagus No advantage when compared with III. Devices: Oxygen Tent (Avoid) Clear Plastic shell encloses upper body Cannot reliably provide stable Oxygen Concentrations Although theoretically 50

2018 FP Notebook

2. Ineffective Oxygen Delivery

Ineffective Oxygen Delivery Ineffective Oxygen Delivery Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ineffective Oxygen Delivery (...) Ineffective Oxygen Delivery Aka: Ineffective Oxygen Delivery , Nasal Catheter , Oxygen Tent II. Devices: Nasal Catheter (Avoid) Flexible lubricated oxygen catheter Holes in distal 2cm Advanced through nostril into pharynx behind uvula Risk of to adenoids and secondary Gastric distention or rupture if cannulate esophagus No advantage when compared with III. Devices: Oxygen Tent (Avoid) Clear Plastic shell encloses upper body Cannot reliably provide stable Oxygen Concentrations Although theoretically 50

2015 FP Notebook

3. CRACKCast E180 – Labor & Delivery

walk through the steps of a normal, spontaneous vertex delivery. Really there are three phases: head, then shoulders, then body and legs! Call for help Prepare your supplies A radiant warmer should be available and heated. Neonatal resuscitation adjuncts should be available, including a towel, scissors, umbilical clamps, bulb suction, airway equipment (oxygen, bag-mask device with appropriate sized masks, and tools for endotracheal intubation), and equipment to achieve vascular access. Don PPE (...) CRACKCast E180 – Labor & Delivery CRACKCast E180 - Labor & Delivery - CanadiEM CRACKCast E180 – Labor & Delivery In by Adam Thomas May 24, 2018 This episode of CRACKCast covers Rosen’s Chapter 181, Labor and Delivery. This chapter covers the high risk realm of ED deliveries, including potential complications such as PROM, malpresentation and umbilical cord emergencies. Shownotes – Key Points All ED deliveries should be considered high risk . Antepartum hemorrhage, PROM, eclampsia, premature

2018 CandiEM

4. Oxygen therapy administration in a non-emergency situation

mask Comes in three sizes: 250mls, 500mls and 1,500mls. The smallest one is ineffective even at birth. Two smallest bags have a pressure limiting valve set at 4.41kPa (45cm H 2 0) to protect the lungs from barotrauma (damage caused to tissues by a change in pressure inside and outside the body). The reservoir bag enables the delivery of oxygen concentrations up to 98 per cent. Without the reservoir bag it is not possible to supply more than 50 per cent oxygen ( ). Selection of most appropriate (...) related disorders palliative care for symptom relief ( ) Inform child and family Age appropriate information must be given to the child. Family members must be adequately informed ( ). Include the following information: need for oxygen therapy rationale and explanation for method of delivery positive/expected benefits of treatment possible side effects of treatment minimum duration of treatment Baseline assessment Wherever possible, a set of baseline observations should always be obtained

2014 Publication 1593

5. Insights on Localized and Systemic Delivery of Redox-Based Therapeutics Full Text available with Trip Pro

Insights on Localized and Systemic Delivery of Redox-Based Therapeutics Reactive oxygen and nitrogen species are indispensable in cellular physiology and signaling. Overproduction of these reactive species or failure to maintain their levels within the physiological range results in cellular redox dysfunction, often termed cellular oxidative stress. Redox dysfunction in turn is at the molecular basis of disease etiology and progression. Accordingly, antioxidant intervention to restore redox (...) homeostasis has been pursued as a therapeutic strategy for cardiovascular disease, cancer, and neurodegenerative disorders among many others. Despite preliminary success in cellular and animal models, redox-based interventions have virtually been ineffective in clinical trials. We propose the fundamental reason for their failure is a flawed delivery approach. Namely, systemic delivery for a geographically local disease limits the effectiveness of the antioxidant. We take a critical look at the literature

2018 Oxidative medicine and cellular longevity

6. Endolysosomal targeting of a clinical chlorin photosensitiser for light-triggered delivery of nano-sized medicines Full Text available with Trip Pro

of the entrapped agents that harnesses sub-lethal photodynamic therapy (PDT) using a photosensitiser that localises in endolysosomal membranes. Using light to trigger reactive oxygen species-mediated rupture of the photosensitised endolysosomal membranes, the spatio-temporal selectivity of PCI then enables cytosolic release of the agents at the selected time after administration so that they can reach their intracellular targets. However, conventional photosensitisers used clinically for PDT are ineffective (...) Endolysosomal targeting of a clinical chlorin photosensitiser for light-triggered delivery of nano-sized medicines A major problem with many promising nano-sized biotherapeutics including macromolecules is that owing to their size they are subject to cellular uptake via endocytosis, and become entrapped and then degraded within endolysosomes, which can significantly impair their therapeutic efficacy. Photochemical internalisation (PCI) is a technique for inducing cytosolic release

2017 Scientific reports

7. Phenotypic correction of Fanconi anemia cells in the murine bone marrow after carrier cell mediated delivery of lentiviral vector Full Text available with Trip Pro

Phenotypic correction of Fanconi anemia cells in the murine bone marrow after carrier cell mediated delivery of lentiviral vector Fanconi anemia (FA) is an autosomal-recessive disorder associated with hematopoietic failure and it is a candidate for hematopoietic stem cell (HSC)-directed gene therapy. However, the characteristically reduced HSC numbers found in FA patients, their ineffective mobilization from the marrow, and re-oxygenation damage during ex vivo manipulation have precluded (...) clinical success using conventional in vitro approaches. We previously demonstrated that lentiviral vector (LV) particles reversibly attach to the cell surface where they gain protection from serum complement neutralization. We reasoned that cellular delivery of LV to the bone marrow niche could avoid detrimental losses during FA HSC mobilization and in vitro modification. Here, we demonstrate that a VSV-G pseudotyped lentivector, carrying the FANCC transgene, can be transmitted from carrier

2016 Stem cell research & therapy

8. COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community

than paper prescriptions • using different methods to deliver medicines to patients, for example pharmacy deliveries, postal services, NHS volunteers or drive-through pick-up points. 1.4 For patients with known or suspected COVID-19, follow appropriate UK government guidance on infection prevention and control. This includes recommendations on patient transfers and on decontaminating reusable equipment between each patient and after patient use. 1.5 If a patient shows typical COVID-19 symptoms (...) recommends using the CRB65 tool, it has not been validated in people with COVID-19. It also requires blood pressure measurement, which may be difficult or undesirable during the COVID-19 pandemic and risks cross- contamination (see recommendation 1.4). 3.6 Where pulse oximetry is available use oxygen saturation levels below 92% (below 88% in people with COPD) on room air at rest to identify seriously ill patients. While the ROTH tool has been suggested as an alternative where pulse oximetry

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

9. COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community

consultations (see BMJ guidance on Covid-19: a remote assessment in primary care for a useful guide including a visual summary for remote consultations) • cutting non-essential face-to-face follow up • using electronic prescriptions rather than paper • using different methods to deliver medicines to patients, for example pharmacy deliveries, postal services, NHS volunteers or introducing drive-through pick-up points for medicines. COVID-19 rapid guideline: managing symptoms (including at the end of life (...) Be aware that older patients or those with comorbidities, frailty, impaired immunity or a reduced ability to cough and clear secretions are more likely to develop severe pneumonia. This could lead to respiratory failure and death. 4.2 If possible, encourage patients with cough to avoid lying on their back because this makes coughing ineffective. 4.3 Use simple measures first, including getting patients with cough to take honey (for patients aged over 1 year). See table 1 for treatments for managing

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

10. Intranasal Naloxone for acute opiate overdose: Reducing needle stick risk, improving time to medication delivery

modality for opioid overdose.[44] [It is not clear why this is reportable or why they make this conclusion. IV naloxone is also ineffective after the first dose 10-15% of the time due to the quantity of opioid consumed. As is very clear in all the provided references on this web page - there is NO 100% reliable single dose delivery method for naloxone. The providers must also support ventilation and if naloxone fails after one dose (given adequate time to be effective) they need to consider redosing (...) Intranasal Naloxone for acute opiate overdose: Reducing needle stick risk, improving time to medication delivery Intranasal naloxone to treat heroin and other opiate overdoses Therapeutic Intranasal Drug Delivery Needleless treatment options for medical problems (Scroll down if the text is missing on your screen) Concepts: Clinical-Uses: Education: Intranasal Naloxone for acute opiate overdose: Reducing needle stick risk, improving time to medication delivery Table of Contents: Literature

2010 Therapeutic Intranasal Drug Delivery

11. Covid-19: Safety of Extended Use and Reuse of N95 Respirators

in H5N1 (Lore et al. 2012), H1N1 (Heimbuch et al. 2011), and S. aureus (Heimbuch et al. 2014) loads on contaminated N95s; however, Heinbuch et al. (2011) found UVGI ineffective on some N95 models, and 1 of the studies reported that inoculation patterns affected UCGI (Woo et al. 2012). - N95 integrity: 2 studies (Vuma et al. 2019, Bergman et al. 2012) reported that 7% to 8% of N95s failed fitting after 2 uses and >20% failed after 5 fittings. 1 study (Lin et al. 2017) reported reduced filtration (...) . Strategies for Optimizing the Supply of N95 Respirators: Crisis/Alternate Strategies. 2020. This guidance describes the following measures that are not commensurate with current U.S. standards of care but may need to be considered during periods of expected or known N95 respirator shortages: o Use of respirators beyond the manufacturer-designated shelf life for healthcare delivery for care of patients with COVID-19, tuberculosis, measles, and varicella can be considered. o Use of respirators approved

2020 Covid-19 Ad hoc papers

12. Factors Informing Clinical Decisions about Ventilator Use during Ventilator Shortages in an Infectious Disease Pandemic

systems and frameworks. - 5 retrospective cohort studies (Shahpori et al., Adeniji and Cusack, Khan et al., Guest et al., and Christian et al.) reported that using SOFA score >11, a predictor of high mortality risk, to relegate patients to palliative care was ineffective for prioritizing care of survivors. Shahpori et al. (n = 10,204) reported patients with H1N1 with SOFA score >11 had only 31% mortality, and Guest et al. (n = 24) found 39% of patients who would have been excluded by SOFA survived (...) . - 1 case series (Estenssoro et al., n = 337) reported APACHE II score, lowest PaO 2/FIO 2 value (oxygen exchange), shock, hemodialysis, and prone positioning each independently predicted mortality in patients with H1N1 infections on mechanical ventilation (p 11 were triaged for palliative care. - 1 retrospective, multicenter cohort study (Christian et al. 2009; n = 234) applied the OHPIP draft triage protocol as a pilot to determine the framework’s effectiveness. Triage officers assigned treatment

2020 Covid-19 Ad hoc papers

13. Safety of Extended Use and Reuse of N95 Respirators

study (Fisher et al. 2012) reported minimal M2 aerosolization ( 10,000-fold reduction in H5N1 (Lore et al. 2012), H1N1 (Heimbuch et al. 2011), and S. aureus (Heimbuch et al. 2014) loads on contaminated N95s; however, Heinbuch et al. (2011) found UVGI ineffective on some N95 models, and 1 of the studies reported that inoculation patterns affected UVGI (Woo et al. 2012). - N95 integrity: 2 studies (Vuma et al. 2019, Bergman et al. 2012) reported that 7% to 8% of N95s failed fitting after 2 uses (...) describes the following measures that are not commensurate with current U.S. standards of care but may need to be considered during periods of expected or known N95 respirator shortages: o Use of respirators beyond the manufacturer-designated shelf life for healthcare delivery for care of patients with COVID-19, tuberculosis, measles, and varicella can be considered. CLINICAL EVIDENCE ASSESSMENT Safety of Extended Use and Reuse of N95 Respirators © April 16, 2020 ECRI | 5 o Use of respirators approved

2020 Covid-19 Ad hoc papers

14. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic Full Text available with Trip Pro

coronavirus disease 2019 ( ) has reached pandemic levels; Patients with cardiovascular ( ) risk factors and established cardiovascular disease ( ) represent a vulnerable population when suffering from ; Patients with cardiac injury in the context of have an increased risk of morbidity and mortality. The causing has reached pandemic levels since March 2020. In the absence of vaccines or curative medical treatment, exerts an unprecedented global impact on public health and health care delivery. Owing

2020 European Society of Cardiology

15. The Vest for delivering high-frequency chest wall oscillation in people with complex neurological needs

, eliminate unlawful discrimination on grounds of race, disability, age, sex, gender reassignment, marriage and civil partnership, pregnancy and maternity (including women post-delivery), sexual orientation, and religion or belief (these are protected characteristics under the Equality Act 2010). The Vest for delivering high-frequency chest wall oscillation in people with complex neurological needs (MIB159) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms (...) The Vest. In 2 studies, there was reduced antibiotic use and a reduced number of chest infections (only 1 study showed a significant reduction in infections). Only 1 study reported oxygen saturation as an outcome. In people with amyotrophic lateral sclerosis, there was a significant reduction in the number of infections. One specialist commentator suggested that The Vest needs to be used for 6 to 12 months before patient benefit can be clearly shown. In people with cerebral palsy, the duration

2018 National Institute for Health and Clinical Excellence - Advice

16. Mechanical thrombectomy devices for acute ischaemic stroke

inner distal diameter. A guide wire is inserted into the patient, followed by a small access catheter. The access catheter is then used to guide the aspiration catheter to the right place. When the clot is reached, it is broken into smaller pieces that can be aspirated through the catheter using a pump or manual suction. Stent retrievers have an expanding wire mesh tube and are intended to remove the clot in 1 piece. The retriever is placed using a delivery catheter, and once in place the mesh (...) features of included stent retrie y features of included stent retriev vers ers De Device vice ( (Compan Company) y) A Available vailable models models Stent diameter and Stent diameter and length in mm length in mm Deliv Delivery catheter: minimum ery catheter: minimum inner diameter in inches inner diameter in inches Aperio (Acandis; UK supplier: Neurologic) 01-000700 01-000701 01-000702 01-000703 3.5×28 4.5×30 4.5×40 6×40 0.0165 to 0.021 0.0165 to 0.021 0.021 to 0.027 0.021 to 0.027 Mechanical

2018 National Institute for Health and Clinical Excellence - Advice

17. Servo-n with Neurally Adjusted Ventilatory Assist (NAVA) for babies and children

characteristics and others. In producing guidance and advice, NICE aims to comply fully with all legal obligations to: promote race and disability equality and equality of opportunity between men and women, eliminate unlawful discrimination on grounds of race, disability, age, sex, gender reassignment, marriage and civil partnership, pregnancy and maternity (including women post-delivery), sexual orientation, and religion or belief (these are protected characteristics under the Equality Act 2010). The Servo-n (...) . Servo-n with Neurally Adjusted Ventilatory Assist (NAVA) for babies and children (MIB163) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 10Intervention and comparator(s) Intervention: Servo-i with NAVA. Comparator: NIV pressure support and NIV flow-triggered pressure support. Key outcomes NAVA showed a statistically significant reduction in the Asynchrony Index (p=0.001) and ineffective breathing efforts (p

2018 National Institute for Health and Clinical Excellence - Advice

18. gammaCore for cluster headache

or oxygen therapy. One specialist noted that gammaCore was portable and easy to use on the go. The specialists agreed that gammaCore could be used by anyone with cluster headache but would be particularly beneficial for those people in whom current treatments are not tolerated or are contraindicated. For example, people for whom triptans, high-flow oxygen and verapamil are ineffective or people with cardiovascular disease. Potential system impact All 4 specialists agreed that gammaCore had the potential (...) to the surface of the neck rather than surgically implanted. The intended place in ther place in therap apy y would be as well as standard care, most likely where standard treatments for cluster headache are ineffective, not tolerated or contraindicated. It would be prescribed by neurologists who provide specialist headache services. The main points from the e main points from the evidence vidence summarised in this briefing are from 5 studies: 3 randomised controlled trials, 1 open-label randomised trial

2018 National Institute for Health and Clinical Excellence - Advice

19. British guideline on the management of asthma

Regular preventer therapy 63 7.3 Initial add-on therapy 70 7.4 Additional controller therapies 72 7.5 Specialist therapies 73 7.6 Deceasing treatment 82 7.7 Specific management issues 82 8 Inhaler devices 85 8.1 Technique and training 85 8.2 ß 2 agonist delivery 85 8.3 Inhaled corticosteroids for stable asthma 86 8.4 Prescribing devices 86 8.5 Use and care of spacers 87 8.6 Environmental impact of metered-dose inhalers 87 9 Management of acute asthma 89 9.1 Lessons from asthma deaths and near-fatal (...) in adolescents 117 11.1 Definitions 117 11.2 Prevalence of asthma in adolescents 117 11.3 Diagnosis and assessment 117 11.4 Risk factors 118 11.5 Comorbidities and modifiable behaviours 119 11.6 Asthma attacks and the risk of hospital admission 120 11.7 Long-term outlook and entry into the workplace 120 11.8 Non-pharmacological management 120 11.9 Pharmacological management 121 11.10 Inhaler devices 121 11.11 Organisation and delivery of care 122 11.12 Patient education and self management 12312 Asthma

2019 SIGN

20. Diagnosis and Management of Acute Pulmonary Embolism Full Text available with Trip Pro

hypotension is a critical element in this process, leading to impairment of the coronary driving pressure to the overloaded RV. The detrimental effects of acute PE on the RV myocardium and the circulation are summarized in Figure . Figure 2 Key factors contributing to haemodynamic collapse and death in acute pulmonary embolism (modified from Konstantinides et al. with permission). A-V = arterio-venous; BP = blood pressure; CO = cardiac output; LV - left ventricular; O2 = oxygen; RV = right ventricular; TV (...) Integration of aggravating conditions and comorbidity into risk assessment of acute pulmonary embolism 20 5.6 Prognostic assessment strategy 20 6 Treatment in the acute phase 22 6.1 Haemodynamic and respiratory support 22 6.1.1 Oxygen therapy and ventilation 22 6.1.2 Pharmacological treatment of acute right ventricular failure 22 6.1.3 Mechanical circulatory support and oxygenation 23 6.1.4 Advanced life support in cardiac arrest 23 6.2 Initial anticoagulation 23 6.2.1 Parenteral anticoagulation 23 6.2.2

2019 European Society of Cardiology

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